Hostname: page-component-848d4c4894-75dct Total loading time: 0 Render date: 2024-05-19T00:55:07.825Z Has data issue: false hasContentIssue false
  • English
  • Français

Evaluation of carotid artery access in comparison with femoral artery access in neonatal percutaneous stenting of ductus arteriosus

Part of: Interventional Cardiology

Published online by Cambridge University Press:  18 February 2021

Gehan A. Alsawah ,
Hala Elmarsafawy Open the ORCID record for Hala Elmarsafawy [Opens in a new window] ,
Mona Hafez  and
Shaimaa Rakha Open the ORCID record for Shaimaa Rakha [Opens in a new window]
Gehan A. Alsawah
Affiliation:
Pediatric Cardiology Unit, Pediatrics Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
Hala Elmarsafawy
Affiliation:
Pediatric Cardiology Unit, Pediatrics Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
Mona Hafez
Affiliation:
Pediatric Cardiology Unit, Pediatrics Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
Shaimaa Rakha*
Affiliation:
Pediatric Cardiology Unit, Pediatrics Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
*
Author for correspondence: Dr S. Rakha, MD, Pediatric Cardiology Unit, Mansoura University Children Hospital, El Gomhouria St, Mansoura, Dakahlia Governorate 35516, Egypt. Tel: +201030077567. E-mail: drshimaarhaka@mans.edueg
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Patent ductus arteriosus stenting in duct-dependent pulmonary circulation is a challenging procedure. Percutaneous carotid artery access for ductal stenting has proven to be feasible; however, comparison with femoral artery access in terms of procedure details and complications either immediate or late is scarce. Therefore, we evaluated carotid artery access in comparison with femoral artery for stenting of patent ductus arteriosus.

Methods:

Forty neonates were reviewed, 20 were stented via carotid artery access, and 20 via the traditional femoral artery access. Comparison variables were neonatal demographics at the procedure, angiographic ductal anatomy, procedure details, and immediate complications. Follow-up Doppler ultrasound on access site was performed to document late complications.

Results:

Median age of included cases was 10.5 (3–28) days with complex ductal anatomy more frequently accessed via carotid artery than femoral. Immediate access-related complications were significantly higher with femoral than carotid artery access; 9 (45%) versus 3 (15%) respectively, p = 0.038. With carotid access, we had only one case with small pseudoaneurysm and acute hemiparesis 3 days after the procedure. Delayed local complications were more common with femoral access (15%) than carotid access (5%), mild stenosis in one case, and severe in another with femoral access; while with transcarotid arterial access, only one case had mild narrowing.

Conclusion:

Percutaneous carotid artery access in neonates is a more convenient approach for patent ductus arteriosus stenting especially with complex ductal anatomy. Moreover, local complications are limited and vascular patency is better preserved, in comparison with trans-femoral arterial access. However, the potential for neurological adverse events should not be overlooked.

Keywords

Carotid artery accesspercutaneousstentductus arteriosus
Type
Original Article
Information
Cardiology in the Young , Volume 31 , Issue 9 , September 2021 , pp. 1465 - 1471
Check for updates
Copyright
© The Author(s), 2021. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Petrucci, O, O’Brien, SM, Jacobs, ML, et al. Risk factors for mortality and morbidity after the neonatal Blalock-Taussig shunt procedure. Ann Thorac Surg 2011; 92: 642–651.CrossRefGoogle ScholarPubMed
Dorobantu, DM, Pandey, R, Sharabiani, MT, et al. Indications and results of systemic to pulmonary shunts: results from a national database. Eur J Cardiothorac Surg 2016; 49: 1553–1563.CrossRefGoogle ScholarPubMed
Gibbs, JL, Rothman, MT, Rees, MR, Parsons, JM, Blackburn, ME, Ruiz, CE. Stenting of the arterial duct: a new approach to palliation for pulmonary atresia. Br Heart J 1992; 67: 240–245.CrossRefGoogle ScholarPubMed
Qureshi, AM, Goldstein, BH, Glatz, AC, et al. Classification scheme for ductal morphology in cyanotic patients with ductal dependent pulmonary blood flow and association with outcomes of patent ductus arteriosus stenting. Catheter Cardiovasc Interv 2019; 93: 933–943.CrossRefGoogle ScholarPubMed
Bauser-Heaton, H, Qureshi, AM, Goldstein, BH, et al. Use of carotid and axillary artery approach for stenting the patent ductus arteriosus in infants with ductal-dependent pulmonary blood flow: a multicenter study from the congenital catheterization research collaborative. Catheter Cardiovasc Interv 2020; 95: 726–733.CrossRefGoogle ScholarPubMed
Hussain, A, Al-Zharani, S, Muhammed, AA, Al-Ata, J, Galal, OM. Midterm outcome of stent dilatation of patent ductus arteriosus in ductal-dependent pulmonary circulation. Congenit Heart Dis 2008; 3: 241–249.CrossRefGoogle ScholarPubMed
Alwi, M. Stenting the ductus arteriosus: case selection, technique and possible complications. Ann Pediatr Cardiol 2008; J1: 38–45.CrossRefGoogle Scholar
Choudhry, S, Balzer, D, Murphy, J, Nicolas, R, Shahanavaz, S. Percutaneous carotid artery access in infants < 3 months of age. Catheter Cardiovasc Interv 2016; 87: 757–761.CrossRefGoogle ScholarPubMed
Azzolina, G, Eufrate, SA, Allella, A. New approach to catheterization of the heart in infants and children. Br Heart J 1973; 35: 643–646.CrossRefGoogle ScholarPubMed
Robinson, BV, Brzezinska-Rajszys, G, Weber, HS, et al. Balloon aortic valvotomy through a carotid cutdown in infants with severe aortic stenosis: results of the multi-centric registry. Cardiol Young 2000; 10: 225–232.CrossRefGoogle ScholarPubMed
Weber, HS, Mart, CR, Kupferschmid, J, Myers, JL, Cyran, SE. Transcarotid balloon valvuloplasty with continuous transesophageal echocardiographic guidance for neonatal critical aortic valve stenosis: an alternative to surgical palliation. Pediatr Cardiol 1998; 19: 212–217.CrossRefGoogle ScholarPubMed
Justino, H, Petit, CJ. Percutaneous common carotid artery access for pediatric interventional cardiac catheterization. Circ Cardiovasc Interv 2016; 9: e003003.CrossRefGoogle ScholarPubMed
Feltes, TF, Bacha, E, Beekman, RH 3rd, et al. Indications for cardiac catheterization and intervention in pediatric cardiac disease: a scientific statement from the American Heart Association. Circulation 2011; 123: 2607–2652.CrossRefGoogle ScholarPubMed
Vitiello, R, McCrindle, BW, Nykanen, D, Freedom, RM, Benson, LN. Complications associated with pediatric cardiac catheterization. J Am Coll Cardiol 1998; 32: 1433–1440.CrossRefGoogle ScholarPubMed
Vermilion, RP, Snider, AR, Bengur, AR, Beekman, RH. Doppler evaluation of femoral arteries in children after aortic balloon valvuloplasty or coarctation balloon angioplasty. Pediatr Cardiol 1993; 14: 13–18.Google ScholarPubMed
Bergersen, L, Marshall, A, Gauvreau, K, et al. Adverse event rates in congenital cardiac catheterization—A multi-center experience. Catheter Cardiovasc Interv 2010; 75: 389–400.Google ScholarPubMed
Cohn, HE, Freed, MD, Hellenbrand, WF, et al. Complications and mortality associated with cardiac catheterization in infants under 1 year: a prospective study. Pediatr Cardiol 1985; 6: 123–131.CrossRefGoogle ScholarPubMed
Kulkarni, S, Naidu, R. Vascular ultrasound imaging to study immediate postcatheterization vascular complications in children. Catheter Cardiovasc Interv 2006; 68: 450–455.CrossRefGoogle ScholarPubMed
Steinberg, C, Weinstock, DJ, Gold, JP, et al. Measurements of central blood vessels in infants and children: normal values. Cathet Cardiovasc Diagn 1992; 27: 197–201.CrossRefGoogle ScholarPubMed
Gasparella, M, Milanesi, O, Biffanti, R, et al. Carotid artery approach as an alternative to femoral access for balloon dilation of aortic valve stenosis in neonates and infants. J Vasc Access 2003; 4: 146–149.CrossRefGoogle ScholarPubMed
Polat, TB. Use of percutaneous carotid artery access for performing pediatric cardiac interventions: single-center study. Ann Pediatr Cardiol 2020; 13: 16–24.CrossRefGoogle ScholarPubMed
Ligon, RA, Kim, DW, Vincent, RN, et al. Angiographic follow-up of infants and children undergoing percutaneous carotid artery interventions. Catheter Cardiovasc Interv 2018; 91: 1301–1306.CrossRefGoogle ScholarPubMed
Golden, LR. Incidence and management of large-bore introducer sheath puncture of the carotid artery. J Cardiothorac Vasc Anesth 1995; 9: 425–428.CrossRefGoogle ScholarPubMed
Guilbert, MC, Elkouri, S, Bracco, D, et al. Arterial trauma during central venous catheter insertion: case series, review and proposed algorithm. J Vasc Surg 2008; 48: 918–925.CrossRefGoogle ScholarPubMed
Polat, TB. Stenting the vertical ductus arteriosus via axillary artery access using “wire-target” technique. Congenit Heart Dis 2017; 12: 800–807.CrossRefGoogle ScholarPubMed